BACKGROUND:Short all-oral regimens for Rifampicin-resistant tuberculosis (ShORRT) have been a turning point in the treatment of drug-resistant tuberculosis. Despite this, access to drugs, stockouts, or adverse effects may limit the use of the recommended regimens. METHODS:Pragmatic non-randomized trial evaluating the efficacy and safety of a ShORRT strategy for the treatment of rifampicin-resistant Tuberculosis (RR-TB) at the Hospital Nossa Senhora da Paz (Angola). The strategy assigned participants to receive a bedaquiline (BDQ) or a linezolid-based (LZF) regimen supplemented with levofloxacin, clofazimine, and cycloserine for up to 9 months. RESULTS:One hundred and twenty-one participants with pulmonary RR-TB were treated with the ShORRT strategy; 69 received the bedaquiline- and 52 the linezolid-based regimen. Overall, 98 (81%) participants had successful treatment outcomes, which was significantly higher compared to a 20-month historical injectable-based regimen (successful outcome rate including cure and treatment completed: 53.7%) (p < 0.001). No significant differences between treatment success rates (85.5% vs. 75.0%), treatment failure (0.0% vs. 1.9%), death (5.8% vs. 13.5%), or lost to follow-up (LTFU) (8.7% vs. 9.6%) were seen between the BDQ and the LZF-based regimen. Globally, 72 adverse events (AE) occurred in 36 (29.7%) participants. Eighteen (14.9%) of these were grade ≥3 and were more frequently observed in those receiving the LZD-based regimen (p = 0.02). CONCLUSION:The ShORRT strategy with a nine-month BDQ- or LZD-based regimen supports the efficacy of shorter all-oral regimens for the treatment of RR-TB and presents real-world data from schemes without bedaquiline, nitroimidazole, or injectables.

INTRODUCTION:Skin conditions commonly affect travelers and migrants. Imported cutaneous lesions may be under-diagnosed and differences may be observed according to type of traveler. The objective of the study was to describe the main imported skin diseases registered in the +Redivi network and analyse distribution and characteristics based on traveler profile. METHODS:A retrospective analysis of data from the +Redivi Spanish national network, October 2009-December 2024, was performed. Patients with a cutaneous syndrome as primary or secondary reason for consultation were included in the analysis. RESULTS:In total, 3437 patients consulted for a cutaneous syndrome (9.5% of the total). Travelers represented 62.4% (2146), migrants 22.4% (769), and VFRs accounted for 15.2% (522) of cases. The median age was 36.1 years (interquartile range [IQR]: 27.7-47.4). The leading conditions were arthropod bites (490, 14.3%), skin and soft tissue infections (384, 11.2%), cutaneous larva migrans (323, 9.4%), arboviral infections with cutaneous manifestations (232, 6.8%) and animal bites (280, 8.2%). Arthropod bites, animal bites, cutaneous larva migrans, and tungiasis were significantly more frequent in travelers (p < 0.001). Arboviral infections with cutaneous involvement were significantly more common in VFRs (p < 0.001) and scabies, superficial fungal infections and skin and soft tissue infections were more common in migrants (p < 0.05). CONCLUSIONS:Significant differences in imported cutaneous conditions according to type of traveler were observed, probably linked to cultural, epidemiological and social factors. These data may be used to tailor pre-travel prevention strategies and to enhance diagnostic guidelines for travel-related skin diseases.

Malaria remains a major cause of morbidity and mortality in Angola, where Plasmodium falciparum accounts for most infections. The widespread use of artemether–lumefantrine (AL) as first-line treatment and sulfadoxine–pyrimethamine (SP) for intermittent preventive treatment in pregnancy (IPTp) exerts selective pressure on local parasite populations. Molecular surveillance of drug resistance markers is essential to monitor susceptibility and anticipate changes that may influence treatment and prevention strategies. This study analyzed pfk13, pfmdr1, pfdhfr, and pfdhps polymorphisms in P. falciparum isolates from Cubal, Benguela province, to assess parasite genetic evolution under AL and SP pressure. A cross-sectional study was conducted between 2022 and 2023 at Hospital Nossa Senhora da Paz (Cubal). A total of 139 real-time PCR–confirmed P. falciparum infections were included. Dried blood spot samples underwent sequencing of the genes involved in resistance. Mutation and haplotype frequencies associated with antimalarial resistance were determined. Among 120 pfk13 sequences, mutations were detected in 12 isolates (10

Schistosomiasis is a neglected tropical disease, affecting 253 million people worldwide. This study aimed to describe the clinical and epidemiological characteristics of schistosomiasis in sub-Saharan African migrants evaluated through a general screening program for imported infectious diseases at a specialized international health unit in Barcelona, Spain. We performed a retrospective observational study (2014–2023) including confirmed (defined by egg detection in stool or urine) and probable cases (identified by positive serology against Schistosoma). Data on epidemiology, clinical presentation, diagnosis, treatment, and follow-up were collected. Among 3214 screened migrants, 855 (26.6

Background: Evidence on adolescent sexual and reproductive health (SRH) in Angola remains scarce, particularly among younger adolescents who are frequently excluded from research. Context-specific data are needed to understand how SRH knowledge translates into behaviours and how structural factors shape adolescents’ ability to act on this knowledge. This study aimed to describe SRH knowledge, behaviours, exposure to violence, and structural vulnerabilities among adolescents aged 11–17 years in Benguela Province, Angola. Methods: We conducted a school-based cross-sectional study in October 2024 among 382 adolescents from urban (n = 282) and rural (n = 100) settings in Benguela Province, selected through systematic random sampling. A culturally adapted questionnaire assessed key SRH domains, including knowledge, sexual behaviours, contraceptive use, menstrual health, pregnancy and abortion, and experiences of sexual and gender-based violence (GBV). Data were analysed using descriptive and bivariate statistics to characterise patterns by sex and residence. Results: Nearly all participants demonstrated adequate SRH knowledge (98.7%). However, only 18.1% reported using any contraceptive method, with pronounced gender disparities, particularly in urban settings (urban boys 34.0% vs. urban girls 7.7%; p < 0.001). Overall, 29.0% reported having engaged in sexual intercourse, and 8.1% reported risky sexual behaviours, including inconsistent condom use during sexual intercourse. Nearly half of adolescents (45.8%) reported experiences of sexual or GBV, with forced sexual acts disproportionately affecting boys, positioning violence as a key constraint on adolescents’ sexual and reproductive agency. Menstrual-related barriers were widespread, affecting 63.5% of urban girls and 80.3% of rural girls, and included missing school or daily activities. Unintended pregnancy was reported by 2.4% of participants, and all reported abortions occurred in urban settings. Conclusions: Despite near-universal SRH knowledge, adolescents face substantial barriers to adopting protective practices. Widespread exposure to violence emerges as a central structural determinant, operating alongside restrictive gender norms, limited access to youth-friendly services, and menstrual health challenges to constrain adolescents’ ability to act on existing knowledge. Improving adolescent SRH in Angola will require moving beyond information-based strategies toward integrated, gender-responsive approaches that combine education with accessible services, menstrual health support, and comprehensive violence-prevention efforts.

Soil-transmitted helminth (STH) infections, caused by Ascaris lumbricoides, Trichuris trichiura, and hookworms, are widely distributed in tropical regions and significantly contribute to morbidity and mortality. These parasites share similar life cycles, and treatment is primarily based on benzimidazoles. This study aims to describe the clinical and epidemiological characteristics of STH cases among migrants and travelers who attended the Vall d’Hebron-Drassanes International Health Unit between 2014 and 2024, the treatments administered, and their efficacy. This retrospective descriptive study reviewed STH cases associated with migration or travel during the period 2014–2024. Diagnosis was established either through identification of eggs or larvae in stool samples or through the detection of adult Ascaris lumbricoides worms in digestive samples, always associated with a migratory process or international travel. Clinical and epidemiological data were collected and analyzed using SPSS. A total of 361 STH cases were identified, with a mean age of 32 years. Of these, 77

Introduction Contact tracing for tuberculosis (TB) is an essential component of public health efforts to detect secondary cases and interrupt transmission chains. This study aimed to assess the risk factors associated with TB diagnosis and to develop a predictive clinical score for TB diagnosis among contacts of people with TB attending the outpatient clinic at Hospital Nossa Senhora da Paz (HNSP) in Cubal, Angola. Methods Prospective observational study including TB contacts of all ages. Data were analyzed using descriptive and inferential statistics, including multivariable logistic regression with multiple imputation for missing data. The performance of the proposed clinical score was assessed through ROC analysis, calibration, bootstrap internal validation, and comparison with the WHO symptom-based screening approach. Results Two-hundred and eighty-five TB contacts were included. Fifty (17.5%) contacts were diagnosed with TB, 40 (80%) of whom were children ≤15 years old. Multivariate analysis identified cough, fever, undernutrition, and peripheral lymphadenopathy as independent risk factors for TB diagnosis. These variables were incorporated into a predictive clinical score ranging from 0 to 17 points. Using a cut-off of ≥6 points, the score showed a sensitivity of 94% and a specificity of 75%, with an area under the ROC curve of 0.89 (95% CI: 0.85–0.94). Conclusions These findings highlight the high burden of TB among close contacts and the challenges in properly assessing them. An easy-to-use clinical score may support frontline health workers in improving TB contact tracing in settings with high burden of disease and limited resources, such as Angola.

Background: Sexual and reproductive health (SRH) knowledge is a key determinant of health outcomes among adolescents and young adults, particularly in low- and middle-income countries. In Angola, young people continue to face substantial SRH challenges, including early childbearing and a high burden of sexually transmitted infections (STIs), yet subnational data remain limited. Objective: To characterise SRH knowledge, sexual behaviours, and STI profiles among adolescents and young adults aged 15–25 years in Benguela Province, Angola. Methods: We conducted a pooled cross-sectional analysis of two independent community-based surveys carried out in 2021 and 2024 in four municipalities of Benguela Province. Participants were recruited through outreach activities in public and community settings. SRH knowledge was assessed using a structured questionnaire, and point-of-care testing was offered for HIV (Alere Determine HIV1/2 antibodies, Abbott), hepatitis B surface antigen (HBsAg) (HBsAg, Nantong diagnosis Biotech-nology), hepatitis C virus (HCV), and syphilis (Treponema pallidum antibodies, Nantong Diagnos Biotechnology). Due to substantial sociodemographic differences between survey rounds, data were pooled and analysed as a single cross-sectional dataset. Multivariate logistic regression was used to identify factors associated with adequate SRH knowledge and HBsAg positivity. Results: A total of 2,802 adolescents and young adults were included. Adequate SRH knowledge was significantly associated with older age, higher educational attainment, and urban residence. While the prevalence of HIV, syphilis, and HCV was low, a high proportion of participants tested positive for HBsAg. HBsAg positivity was more frequent among males and among participants residing in Cubal and Benguela municipalities. Conclusions: Important inequalities in SRH knowledge persist among adolescents and young adults in Benguela Province, particularly affecting younger, with lower education level, and rural populations. The high proportion of HBsAg positivity highlights the need to strengthen hepatitis B prevention strategies, including catch-up vaccination, expanded screening, and integration of HBV services into youth-friendly SRH programmes. These findings underscore the importance of equitable access to SRH information and services to reduce preventable health risks among young people in Angola.

Plasmodium malariae remains one of the most neglected human malaria parasites. Historically considered of low prevalence and limited clinical significance, emerging evidence suggests its true burden may be underestimated due to diagnostic challenges and the parasite’s ability to persist at low densities. A retrospective observational study was conducted at the Vall d’Hebron–Drassanes International Health Unit (Barcelona) from June 2015 to May 2025. Malaria diagnosis was performed using microscopy or quantitative PCR (qPCR), with the diagnostic method selected according to clinical presentation and epidemiological risk. Clinical and epidemiological data were collected and analyzed by descriptive statistics. Among 6,293 individuals screened for malaria, 404 (6.4

Background Current guidelines recommend treating chronic Chagas disease (CD) with benznidazole up to 50 years of age, with individualized decisions in older individuals due to limited safety data. We aimed to compare the safety, tolerability and long-term outcomes of benznidazole in individuals above and below 50 years. Methods We conducted a retrospective cohort study at Vall d’Hebron-Drassanes (Barcelona), including individuals aged 35-69 years treated with benznidazole between 2008 and 2017. Participants were divided into two age groups: (35-49 and 50-69 years), with biannual follow-up. The primary outcome was treatment discontinuation due to toxicity. Secondary outcomes included adverse events (AEs), cardiac progression, and other clinical events over 5 years. Results A total of 339 patients were included, of whom 59 (17.4%) were ≥50 years. AEs occurred in 82% of individuals, with no significant differences between groups (p=0.50). Cutaneous reactions were the most frequent AEs (54%), and did not differ significantly by age (57% vs. 46%, p=0.11). Treatment discontinuation due to toxicity was similar in older and younger individuals (20.3% vs. 13.7%; p=0.19). Cardiac progression was more frequent in older individuals (1.73 vs. 0.68 events/100 person-years; p=0.03), though this was not significant after adjustment (p=0.52). New cardiovascular risk factors and malignancies were more frequent in older individuals. Conclusions Benznidazole was associated with a high frequency of adverse events and a clinically relevant rate of treatment discontinuation, with no statistically significant differences between age groups. These findings support considering benznidazole in selected individuals over 50, suggesting that age alone should not prevent treatment.

OBJECTIVES:Toxocariasis is a zoonotic helminthic infection caused by Toxocara canis and Toxocara cati, parasites commonly found in dogs and cats. It is endemic in many low- and middle-income countries, but cases are increasingly reported in non-endemic areas due to global mobility. The aim of this study is to describe the epidemiological and clinical characteristics of patients diagnosed with imported toxocariasis. METHODS:This is a retrospective of all imported toxocariasis cases diagnosed at the Vall d'Hebron-Drassanes International Health Unit in Barcelona, Spain (2014-2024). Diagnosis of toxocariasis was defined by a positive serological test accompanied by clinical and/or labouratorial alterations compatible with the diagnosis. We collected demographic, epidemiological, clinical and therapeutic information from electronic medical records. RESULTS:Eighty-seven cases of toxocariasis were included. Mean age of patients was 37.2 (SD 18.3) years and 47 (54.0%) were male. Most patients (82, 94.3%) were migrants, and five (5.8%) patients were travellers. Only 20 (23.0%) patients reported having symptoms, with gastrointestinal disturbances being the most common (11, 12.6%). Eosinophilia was present in 64 (74.4%) patients and elevated IgE (58, 84.0%) was common. Co-infections were observed in 26 (29.9%) patients. Of patients that received treatment, most were given albendazole (79, 96.3%). The majority who attended a follow-up appointment showed normalisation in laboratory results despite some remaining seropositive for Toxocara canis. CONCLUSIONS:These findings underscore the need to consider testing for toxocariasis when treating patients with eosinophilia who have visited endemic areas and highlight the value of a One Health approach in understanding, preventing and managing zoonotic diseases.

BACKGROUND AND OBJECTIVE:There is little information on sexual and reproductive health knowledge (SRHK) and practices in Angola and no data on the prevalence of sexually transmitted infections. The objective of this study was to assess the SRHK and behaviors, and estimate the prevalence of four sexually transmitted infections (STIs) among adolescents and young adults from 4 municipalities in Benguela province, Angola prior to an educational intervention. MATERIAL AND METHODS:We performed a cross-sectional study to assess SRHK and sexual behavior using a structured questionnaire among adolescents and young adults aged 15 to 25 years old from two urban and two rural municipalities of Benguela province. We also evaluated the prevalence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), hepatitis B virus (HBV) and syphilis using rapid tests. RESULTS:A total of 1400 youths were included in the study. Overall, 818 (58.4%) participants had adequate SRHK. Urban origin [odds ratio (OR) 1.52, 95% confidence interval (CI) 1.35-2.04], older age (OR 1.14, 95% CI 1.09-1.20), being female (OR 2.06, 95% CI 1.57-2.71) and having journals and internet as the main sources of information (OR 1.37, 95% CI 1.00-1.86 and OR 2.33, 95% CI 1.69-3.21, respectively) were significantly associated to a good SRHK in the multivariate analysis. Four hundred and fifty-three [45.9% of those who have had sexual intercourse (n = 986)] reported risky sexual behavior. We observed that risky sexual behavior was associated with male gender (OR 2.89 95% CI 2.13-3.92, P< .001). Prevalence of STI was: 5 (0.35%) for HIV, 190 (13.6%) for HBV, 4 (0.3%) for HCV, and 20 (1.4%) for syphilis. CONCLUSION:SRHK was higher than expected although in-depth knowledge was uncommon, especially in men from rural areas with lack of access to journals or the internet. Unsafe sexual behavior was widespread among our sample. Prevalence of HBV was higher than expected. Sexual education campaigns using both digital and non-digital approaches should be focused on reaching the young population dispersed in rural areas where internet connection is difficult and should be accompanied by HBV vaccination promotion.

Abstract Background Malaria is the parasitic disease with the highest morbidity and mortality worldwide. Angola is one of the five sub-Saharan African countries with the highest malaria burden. Real-time PCR diagnosis in endemic areas has not been implemented due to its high cost and the need for adequate infrastructure. Dried blood spots (DBSs) are an alternative for collecting, preserving, and transporting blood samples to reference laboratories. The objective of the study was to assess the efficacy of DBS as a sampling method for malaria research studies employing real-time PCR. Methods The study was divided into two phases: (i) prospective study at the Hospital Universitario Vall d'Hebron (HUVH) to compare real-time PCR from whole blood or DBS, including 12 venous blood samples from patients with positive real-time PCR for Plasmodium spp. and 10 quality control samples (nine infected samples and one negative control). Samples were collected as DBSs (10, 20, 50 µl/circle). Samples from both phases of the study were analyzed by generic real-time PCR (Plasmodium spp.) and the subsequent positive samples underwent species-specific real-time PCR (Plasmodium species) and (ii) cross-sectional study conducted at the Hospital Nossa Senhora da Paz, Cubal (Angola), including 200 participants with fever. For each patient, a fresh capillary blood specimen [for thin and thick blood films and rapid diagnostic test (RDT)] and venous blood, collected as DBSs (two 10-µl circles were combined for a total volume of 20 µl of DBS), were obtained. DBSs were sent to HUVH, Barcelona, Spain. Results (i) Real-time PCR from whole blood collection was positive for 100% of the 21 Plasmodium spp.-infected samples, whereas real-time PCR from DBSs detected Plasmodium spp. infection at lower proportions: 76.19% (16/21) for 10 µl, 85.71% (18/21) for 20 µl, 88.24% (15/17) for 50 µl and 85.71% (18/21) for 100 µl DBSs. (ii) Field diagnosis (microscopy and/or RDT) showed a 51.5% (103/200) positivity rate, while 50% (100/200) of the DBS samples tested positive by real-time PCR. Using field diagnosis as the reference method, the sensitivity of real-time PCR in DBS samples was 77.67% with a specificity of 79.38%. Plasmodium species were identified in 86 samples by real-time PCR: 81.40% (16/86) were caused by Plasmodium falciparum, 11.63% (10/86) were coinfections of P. falciparum + P. malariae, 4.65% (4/86) were P. falciparum + P. ovale, and 2.33% (2/86) were triple coinfections. Conclusions The DBS volume used for DNA extraction is a determining factor in the performance of real-time PCR for Plasmodium DNA detection. A DBS volume of 50–100 µl appears to be optimal for malaria diagnosis and Plasmodium species determination by real-time PCR. DBS is a suitable method for sample collection in Cubal followed by real-time PCR analysis in a reference laboratory. Graphical Abstract

Schistosomiasis is a parasitic disease caused by trematodes of the genus Schistosoma . It is classified as a neglected tropical disease by the WHO and has the second highest morbidity of a parasitic disease after malaria. Our objective with this study was to describe radiological findings in patients diagnosed with imported schistosomiasis among migrants and international travelers seen at an international health unit. This is a descriptive, observational, single-center, retrospective study conducted at the International Health Unit, Vall d’Hebron-Drassanes, in which we analyze the radiological findings in patients diagnosed with schistosomiasis. Among the 671 individuals treated for schistosomiasis between 2014 and 2022, 132 (19.7%) underwent a radiological test, 39 (29.5%) were diagnosed with confirmed urinary schistosomiasis, 25 (18.9%) were diagnosed with intestinal schistosomiasis, and 68 (51.5%) were classified as probable cases (positive serology). In all cases, an abdominal ultrasound was performed, and eight patients (6%) also underwent an abdominal computed tomography scan. Abnormalities were found in 19 (14.4%) patients, with the most frequent findings being splenomegaly (nine cases) and bladder wall thickening (five cases). Radiological tests, especially ultrasounds, are highly useful in assessing the severity of the disease and identifying associated lesions.

Cutaneous larva migrans (CLM) is a clinical syndrome typically found in tropical and subtropical regions. The objective of the study is to describe the epidemiological, clinical, and therapeutic characteristics of patients with CLM acquired during international travel. This retrospective observational study analyzes CLM cases treated at an international health unit in Spain. Sociodemographic, clinical, laboratory, and treatment-related data were collected. Overall, 107 cases were diagnosed, 63 (58.9%) of them in women, with a mean age of 32.6 years. Most frequent geographic regions of CLM acquisition were Southeast Asia (38 cases, 35.5%) and South America (28, 26.2%). Patients had a median of one skin lesion (range 1-11) located mainly in the lower extremities (83, 77.6%). Treatment was administered in 105 cases (98.1%), with albendazole used in 88 (83.8%), ivermectin in nine (8.6%), mebendazole in six (5.7%), and two cases lacking drug information (1.9%). Among treated cases, clinical resolution was achieved in 88 (83.8%) patients. Symptoms persisted in 17 (16.2%) cases, and recurrence was observed in 14 (13.3%) cases. A total of 26 (24.8%) patients required re-treatment with either albendazole or ivermectin (61.5% and 38.5%, respectively). The resolution rates for ivermectin, albendazole, and mebendazole were 88.9%, 88.6%, and 0.0%, respectively. CLM is a common syndrome in certain geographic regions and is more frequently diagnosed in international travelers. A thorough epidemiological assessment, along with a detailed medical history and physical examination, facilitates early diagnosis and treatment. Currently, ivermectin and albendazole appear to achieve the highest cure rates with lower recurrence rates.

Schistosomiasis, a major neglected tropical disease, is caused by Schistosoma spp. It is estimated that more than 200 million people are affected worldwide, mostly in Africa. The gold standard diagnosis of urogenital schistosomiasis (UGS) is the microscopic visualisation of Schistosoma haematobium eggs in concentrated urine; however, its sensitivity is low. This study aimed to evaluate the effectiveness of molecular and serological testing for imported UGS screening in asymptomatic sub-Saharan migrants in a non-endemic setting. A retrospective cross-sectional study between November 2021 and December 2022 was conducted by collecting demographic, clinical and laboratory data from the medical records of migrants from endemic areas screened for UGS at the International Health Unit Vall d’Hebron-Drassanes, Barcelona, Spain. Urine samples were analysed by real-time PCR for S. haematobium DNA and by microscopy for egg detection. Serum samples were tested using a serological assay based on enzyme-linked immunosorbent assay (ELISA). UGS was confirmed by a positive result in real-time PCR and/or microscopy, while possible UGS was defined as a case with only a positive serological result. A total of 604 patients were included in this study; 32 out of 604 (5.3

Four patients from Sub-Saharan Africa were infected by Plasmodium ovale and simultaneously presented with glucose-6-phosphate dehydrogenase deficiency. Primaquine 0.75 mg/kg once a week during 8 weeks was administered with a close hematologic follow-up. Non-significant alterations in hemogram and hemolytic parameters were observed in any case.

BACKGROUND:Young women (YW) in Angola face multiple, intersecting challenges related to sexual and reproductive health (SRH), including high rates of early and unintended pregnancy, limited access to contraception, gender-based violence (GBV), and unsafe abortion. These issues are shaped by structural inequalities, restrictive laws, stigma, and inadequate youth-friendly services. Despite the urgency, qualitative research exploring youth perspectives on SRH in Angola remains scarce. METHODS:This qualitative study was conducted in May 2023 in Benguela Province, Angola, as part of the formative phase of the [Anonymised] project. Four focus group discussions (FGDs) were held with 27 young people aged 18-25, stratified by sex and setting (urban Lobito, rural Cubal). Participants were purposively selected to ensure diversity of background and recruited through civil society networks. Discussions followed a semi-structured guide and were analysed using thematic content analysis, integrating systems thinking and Bronfenbrenner's ecological model. RESULTS:Participants identified early pregnancy as the most pressing concern, frequently linked to stigma, misinformation, social pressure, and lack of confidential services. Contraceptive use was limited by fear, myths, and gender dynamics, with abortion often emerging as a stigmatized but common response to unintended pregnancy. Testimonies revealed four "Itineraries of Reality" (IR): [1] abortion as moral crime [2], clandestine abortion as escape [3], forced continuation of pregnancy, and [4] an aspirational path toward safe, legal abortion. These trajectories were embedded in two "Vulnerability Circuits" (VC): unsafe abortion and intergenerational poverty. However, two Exit Strategies (ES)-social activism and legal-health system reform-and one Empowerment Pathway (EP) linked to youth-led associations and community spaces emerged as means of resistance and resilience. CONCLUSIONS:Young people's SRH decisions in Benguela are shaped not only by individual attitudes but by social norms, gender inequality, systemic barriers, and restrictive policies. Early motherhood often reflects constrained agency rather than choice. Addressing these issues requires expanding SRH education and services, decriminalizing abortion, and strengthening youth empowerment mechanisms. Findings support the design of rights-based, context-sensitive interventions rooted in young people's lived realities.

INTRODUCTION:International organisations, scientists and the tuberculosis (TB) community have been advocating for a shorter, safer treatment for drug-susceptible (DS)-TB with equal or better efficacy than current regimens. A promising approach to achieve this is the combination of dose-optimised repurposed drugs. METHODS AND ANALYSIS:The RML-TB trial is a phase IIb, randomised, non-inferiority, controlled, open-label, multicentre clinical trial. It compares an experimental regimen (optimised-dose rifampicin (R) at 30mg/kg/day, moxifloxacin 600mg/day and linezolid (L) 600 mg/day) with the standard fixed-dose combination regimen of R, isoniazid, pyrazinamide and ethambutol. In the experimental arm, L is administered at 600 mg two times per day for 2 weeks, then once daily for 6 weeks. The primary efficacy outcome is the proportion of patients with negative culture at 8 weeks. Sputum samples will be collected at screening visit, randomisation visit and 1 week, 2 weeks, 4 weeks, 6 weeks and 8 weeks post randomisation. The primary safety outcome is the incidence of grade 3-4 adverse events or a change in treatment regimen within 8 weeks. Safety assessment will be done using the Common Terminology Criteria for Adverse Events classification version 5. Participants must be at least 18 years old, with smear-positive, DS pulmonary TB. Exclusion criteria include corrected QT interval (QTc) prolongation, HIV positive status, severely impaired blood counts or the use of QTc-prolonging drugs. The study will enrol 120 patients (60 per arm) over a 2.5-year period across 13 TB units in Spain. ETHICS AND DISSEMINATION:The study was approved by the ethics committee from Vall d'Hebron University Hospital on the meeting held on 18 March 2022 and The Spanish Drug Agency. Patients will provide informed consent and can withdraw from the trial at any time without giving any reason. This decision will not affect their medical care. Data collection is minimal, and analysis will be blinded. Personal data will be restricted to principal investigators or authorised personnel. Results will be shared via the European Union Drug Regulating Authorities Clinical Trials Database (EUDRACT) website and published in an open-source medical journal, guiding future TB clinical trials and treatment development. TRIAL REGISTRATION NUMBER:EUDRACT number: 2021-001626-22. CTIS: 2023-509075-17-00.

Systematic screening of tuberculosis (TB) using molecular testing on stool samples detected TB in 5.2% of acutely malnourished children, including cases without evident clinical symptoms. This screening strategy could enhance TB diagnosis and facilitate prompt treatment initiation in this population. Further studies are required to confirm long-term outcomes and cost-effectiveness.